Provider Demographics
NPI:1861728412
Name:JOHNSON, KRISTA LYNN (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:KLOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:17500 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-536-2376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA. 10770-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics